Electrolytes: Relevance and impact, Schemes and Mind Maps of Medicine

Download Electrolytes: Relevance and impact and more Schemes and Mind Maps Medicine in PDF only on Docsity!

Electrolytes:

Relevance and impact

Key information on sodium, magnesium and calcium

Definition Sodium is the most prevalent electrolyte in the extracellular fluid, playing an essential role in cellular homeostasis^1

Physiological role Adequate amounts of sodium (1.5 g/day) are needed in the diet to maintain optimal nerve and muscle function, fluid and electrolyte balance, and blood pressure^1

Potential risks

• (^) High intakes of sodium from diet and medications

are known to increase extracellular fluid volume and blood pressure, which may accelerate disease progression in chronic kidney disease (CKD) and heart failure (HF) patients2–

• (^) Consequently, KDIGO and ESC Guidelines

recommend that patients with CKD, HF and hypertension limit their dietary sodium intake (<2 g/day) to minimise the risk of adverse renal and cardiovascular outcomes5–

Sodium

*Since the in vivo efficiency of sodium-potassium exchange resins is approximately 33%, about one third of the resin’s actual sodium content is being delivered to the body.

1. Strazzullo P & Leclercq C. ASN Adv Nutr 2014;5(2):188–90. 2. Visser FW, et al. Obesity 2009;17(9):1684–8. 3. Clegg DJ, et al. Mayo Clin Proc 2017;92(8): 1248–60. 4. George J, et al. BMJ 2013;347:1–8. 5. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. 6. McMurray JJV, et al. Eur Heart J 2012;33:1787–847. 7. Williams B, et al. Eur Heart J 2018;39:3021–104. 8. Kayexalate®^ Prescribing Information (Canada). Sanofi 2014.
2. Li L, et al. J Card Pharmacol Ther 2016;21(5):456–65. 10. Veltassa®^ EU SmPC, 2017.

Implication and Relevance

• Depending on the dosing regimen, some potassium binders (e.g. sodium polystyrene sulphonate) indicated for the treatment of hyperkalaemia may contain up to three times (6.0 g)* the guideline recommended dose of sodium for patients with CKD, HF and hypertension (<2 g/day)5–7,
• The sodium content in these potassium binders may compromise the efficacy of RAASi therapy, and worsen symptoms of CKD, HF and hypertension^3

Relevance to Veltassa®

• (^) Veltassa®^ binds potassium in exchange for calcium instead of sodium, and is excreted with potassium to lower total body K+^ levels9,
• (^) Ensures suitability for patients who cannot tolerate even a small increase in sodium load, such as your patients with severe heart failure, hypertension or marked oedema9,

Na+

Calcium

Definition The majority of calcium in the body (99%) is stored in bones and teeth as a calcium-phosphate crystal lattice called hydroxyapatite1,

Physiological role Adequate calcium intake is required for normal growth, development and skeletal strength. In addition, small serum calcium levels are necessary for muscle function, nerve transmission, hormonal secretion and vascular contraction.^2 According to the EFSA, all adults aged ≥25 years (including lactating and pregnant women) should consume at least 750 mg of calcium each day^3

Potential risks As CKD progresses, and the kidneys stop functioning, calcitriol production ceases and parathyroid hormone levels excessively increase to maintain serum calcium levels. As a result, calcium is extracted from bones in order to maintain adequate levels in the blood, which increases the risk of fractures and osteoporosis. In addition, the excessive production of parathyroid

EFSA, European Food Safety Authority; GI, gastrointestinal.

1. Hill Gallant KM & Spiegel DM. Curr Osteoporos Rep 2017;15:214–21. 2. Flynn A. Proceedings of the Nutrition Society 2003;62:851–8. 3. Scientific Opinion on Dietary Reference Values for calcium. European Food Safety Authority Journal 2015;13(5):4101. 4. Nigwekar SU, et al. Bonekey Rep 2014;3:498. 5. Weir MR, et al. Am J Med 2018;131(5):555–64. 6. Bushinsky DA, et al. Clin J Am Soc Nephrol 2016;11(10):1769–76. 7. Bushinsky DA, et al. Am J Nephrol 2016;44:404–10.

Ca2+

Relevance of calcium in Veltassa®

• (^) Veltassa®^ uses calcium as the counter-exchange ion for potassium, with approximately 1.6 g of calcium complexed within an 8.4 g dose of Veltassa®
• (^) Veltassa®^ is designed to ensure that most of the calcium exchanged for potassium occurs in the colon, where calcium absorption is minimal; with a small calcium fraction being released during transit through the GI system6,
• Studies in healthy individuals have shown that about 73 mg of calcium are absorbed into the body from a maximal recommended daily dose (25.2 g) of Veltassa®; such amounts being unlikely to increase the risk of vascular calcification in CKD patients6,

hormone can result in high calcium blood levels (hypercalcaemia), increasing the risk of vascular calcification, atherosclerosis and cardiovascular disease^4

For full prescribing information refer to the Summary of Product Characteristics (SmPC).

Presentation and active ingredient: Patiromer (as patiromer sorbitex calcium) powder for oral suspension available in sachets containing either 8.4 g, 16.8 g or 25.2 g.

Indication: Treatment of hyperkalaemia in adults.

Dosage and Administration: The recommended starting dose of Veltassa® is 8.4 g administered orally once-daily with or without food. The daily dose may be adjusted by 8.4 g as needed at one-week intervals or longer to reach desired serum potassium target range, up to a maximum dose of 25.2 g daily. If serum potassium falls below the desired range, the dose should be reduced or discontinued. If a dose is missed, the missed dose should be taken as soon as possible on the same day and should not be taken with the next dose. Veltassa® may affect certain oral medicines taken at the same time, such as ciprofloxacin, levothyroxine, metformin and quinidine and therefore Veltassa® administration should be separated by at least 3 hours from other oral medicinal products. The onset of action of Veltassa® occurs 4–7 hours after administration. Veltassa® should not replace emergency treatment for life-threatening hyperkalaemia. There is limited data on the use of Veltassa® in patients on dialysis; no special dose and administration guidelines were applied to these patients in clinical studies.

Contraindications: Veltassa® is contraindicated in patients with a history of a hypersensitivity reaction to Veltassa® or any of its excipients including xanthan gum.

Special warnings and precautions: Due to potential hypomagnesaemia, serum magnesium should be monitored for at least 1 month after initiating treatment, and magnesium supplementation considered in patients who develop low serum magnesium levels. A risk/benefit evaluation is required in patients with current or a history of severe gastrointestinal disorders, before and during treatment. When discontinuing Veltassa®, serum potassium levels may rise, especially if RAAS inhibitor treatment is continued, so patients should be instructed

not to discontinue therapy without consulting their physicians. Increases in serum potassium may occur as early as 2 days after the last Veltassa® dose. Serum potassium should be monitored when clinically indicated, including after changes are made to medicinal products that affect the serum potassium concentration (e.g. RAAS inhibitors or diuretics) and after the Veltassa® dose is titrated. Veltassa® contains sorbitol as part of the counterion complex (4.0 g per 8.4 g of patiromer), therefore patients with hereditary problems of fructose intolerance should not take this medicine. Veltassa® contains calcium as part of the counterion complex; calcium is partially released, some of which may be absorbed therefore a risk/benefit evaluation is required in patients at risk of hypercalcaemia. There are limited clinical data in patients with end-stage renal disease and in patients with serum potassium concentrations greater than 6.5 mEq/L.

Overdosage: Since excessive doses of Veltassa® may result in hypokalaemia, serum potassium levels should be monitored.

Special populations: The use of Veltassa® has not been studied in children under 18 years. Since there are no data from the use of patiromer in pregnant women, it is preferable to avoid the use of Veltassa® during pregnancy. No special dose and administration guidelines are recommended for elderly population.

Undesirable effects: Common (≥1/100 to <1/10): hypomagnesaemia, constipation, diarrhoea, abdominal pain, flatulence. Please consult the SmPC in relation to other undesirable effects.

Prescription Only Medicine. Full prescribing information is available on request. Please read the full SmPC prior to administration. Veltassa® is a registered trademark.

Date of preparation: November 2020

API job number: HQ-PAT-

[TO BE COMPLETED WITH LOCAL REQUIREMENTS (e.g. MA number, contact address, adverse events reporting details, price, date of revision)]

Abbreviated prescribing information Veltassa

®